|
RETROFUSION SCREW 24MM
|
Facility
|
OP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem Medicaid |
$1,842.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Humana KY Medicaid |
$1,842.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,860.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,878.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
RETROFUSION SCREW 24MM
|
Facility
|
IP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
RETROGRADE PYELOGRAM W/WO KUB
|
Professional
|
Both
|
$826.00
|
|
|
Service Code
|
HCPCS 74420
|
| Hospital Charge Code |
32000144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.46 |
| Max. Negotiated Rate |
$495.60 |
| Rate for Payer: Aetna Commercial |
$190.23
|
| Rate for Payer: Ambetter Exchange |
$70.57
|
| Rate for Payer: Anthem Medicaid |
$86.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$70.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$70.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$84.68
|
| Rate for Payer: Cash Price |
$413.00
|
| Rate for Payer: Cash Price |
$413.00
|
| Rate for Payer: Cigna Commercial |
$182.92
|
| Rate for Payer: Healthspan PPO |
$237.76
|
| Rate for Payer: Humana Medicaid |
$86.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$23.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$70.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.26
|
| Rate for Payer: Molina Healthcare Passport |
$86.53
|
| Rate for Payer: Multiplan PHCS |
$495.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$91.74
|
| Rate for Payer: UHCCP Medicaid |
$289.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$70.57
|
|
|
RETROGRADE PYELOGRAM W/WO KUB
|
Facility
|
IP
|
$826.00
|
|
|
Service Code
|
HCPCS 74420
|
| Hospital Charge Code |
32000144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$247.80 |
| Max. Negotiated Rate |
$792.96 |
| Rate for Payer: Aetna Commercial |
$636.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$644.28
|
| Rate for Payer: Cash Price |
$413.00
|
| Rate for Payer: Cigna Commercial |
$685.58
|
| Rate for Payer: First Health Commercial |
$784.70
|
| Rate for Payer: Humana Commercial |
$702.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$677.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$609.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.88
|
| Rate for Payer: Ohio Health Group HMO |
$619.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.94
|
| Rate for Payer: PHCS Commercial |
$792.96
|
| Rate for Payer: United Healthcare All Payer |
$726.88
|
|
|
RETROGRADE PYELOGRAM W/WO KUB
|
Facility
|
OP
|
$826.00
|
|
|
Service Code
|
HCPCS 74420
|
| Hospital Charge Code |
32000144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$284.06 |
| Max. Negotiated Rate |
$792.96 |
| Rate for Payer: Aetna Commercial |
$636.02
|
| Rate for Payer: Anthem Medicaid |
$284.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$644.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$413.00
|
| Rate for Payer: Cash Price |
$413.00
|
| Rate for Payer: Cigna Commercial |
$685.58
|
| Rate for Payer: First Health Commercial |
$784.70
|
| Rate for Payer: Humana Commercial |
$702.10
|
| Rate for Payer: Humana KY Medicaid |
$284.06
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$286.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$677.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$609.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$289.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.88
|
| Rate for Payer: Ohio Health Group HMO |
$619.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.94
|
| Rate for Payer: PHCS Commercial |
$792.96
|
| Rate for Payer: United Healthcare All Payer |
$726.88
|
|
|
RETROGRADE PYELOGRAM W/WO KU(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 74420
|
| Hospital Charge Code |
320P0144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.46 |
| Max. Negotiated Rate |
$237.76 |
| Rate for Payer: Aetna Commercial |
$190.23
|
| Rate for Payer: Ambetter Exchange |
$70.57
|
| Rate for Payer: Anthem Medicaid |
$86.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$70.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$70.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$84.68
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$182.92
|
| Rate for Payer: Healthspan PPO |
$237.76
|
| Rate for Payer: Humana Medicaid |
$86.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$23.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$70.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.26
|
| Rate for Payer: Molina Healthcare Passport |
$86.53
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$91.74
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$70.57
|
|
|
RETROGRADE PYELOGRAM W/WO KU(T
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
HCPCS 74420
|
| Hospital Charge Code |
320T0144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$225.30 |
| Max. Negotiated Rate |
$720.96 |
| Rate for Payer: Aetna Commercial |
$578.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.78
|
| Rate for Payer: Cash Price |
$375.50
|
| Rate for Payer: Cigna Commercial |
$623.33
|
| Rate for Payer: First Health Commercial |
$713.45
|
| Rate for Payer: Humana Commercial |
$638.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$554.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.88
|
| Rate for Payer: Ohio Health Group HMO |
$563.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$653.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$518.19
|
| Rate for Payer: PHCS Commercial |
$720.96
|
| Rate for Payer: United Healthcare All Payer |
$660.88
|
|
|
RETROGRADE PYELOGRAM W/WO KU(T
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
HCPCS 74420
|
| Hospital Charge Code |
320T0144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$258.27 |
| Max. Negotiated Rate |
$720.96 |
| Rate for Payer: Aetna Commercial |
$578.27
|
| Rate for Payer: Anthem Medicaid |
$258.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$375.50
|
| Rate for Payer: Cash Price |
$375.50
|
| Rate for Payer: Cigna Commercial |
$623.33
|
| Rate for Payer: First Health Commercial |
$713.45
|
| Rate for Payer: Humana Commercial |
$638.35
|
| Rate for Payer: Humana KY Medicaid |
$258.27
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$260.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$554.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.88
|
| Rate for Payer: Ohio Health Group HMO |
$563.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$653.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$518.19
|
| Rate for Payer: PHCS Commercial |
$720.96
|
| Rate for Payer: United Healthcare All Payer |
$660.88
|
|
|
RETROVIR EQUIV 5MG/0.5MLSYR
|
Facility
|
OP
|
$4.35
|
|
|
Service Code
|
NDC 65862004824
|
| Hospital Charge Code |
25003408
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Anthem Medicaid |
$1.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.61
|
| Rate for Payer: First Health Commercial |
$4.13
|
| Rate for Payer: Humana Commercial |
$3.70
|
| Rate for Payer: Humana KY Medicaid |
$1.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.83
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.00
|
| Rate for Payer: PHCS Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Payer |
$3.83
|
|
|
RETROVIR EQUIV 5MG/0.5MLSYR
|
Facility
|
IP
|
$4.35
|
|
|
Service Code
|
NDC 65862004824
|
| Hospital Charge Code |
25003408
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.61
|
| Rate for Payer: First Health Commercial |
$4.13
|
| Rate for Payer: Humana Commercial |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.83
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.00
|
| Rate for Payer: PHCS Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Payer |
$3.83
|
|
|
RETROVIR (ZIDOVUDINE) 10 100MG
|
Facility
|
OP
|
$9.51
|
|
|
Service Code
|
NDC 65862010701
|
| Hospital Charge Code |
25001321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$9.13 |
| Rate for Payer: Aetna Commercial |
$7.32
|
| Rate for Payer: Anthem Medicaid |
$3.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.42
|
| Rate for Payer: Cash Price |
$4.76
|
| Rate for Payer: Cigna Commercial |
$7.89
|
| Rate for Payer: First Health Commercial |
$9.03
|
| Rate for Payer: Humana Commercial |
$8.08
|
| Rate for Payer: Humana KY Medicaid |
$3.27
|
| Rate for Payer: Kentucky WC Medicaid |
$3.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.37
|
| Rate for Payer: Ohio Health Group HMO |
$7.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.56
|
| Rate for Payer: PHCS Commercial |
$9.13
|
| Rate for Payer: United Healthcare All Payer |
$8.37
|
|
|
RETROVIR (ZIDOVUDINE) 10 100MG
|
Facility
|
IP
|
$9.51
|
|
|
Service Code
|
NDC 65862010701
|
| Hospital Charge Code |
25001321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$9.13 |
| Rate for Payer: Aetna Commercial |
$7.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.42
|
| Rate for Payer: Cash Price |
$4.76
|
| Rate for Payer: Cigna Commercial |
$7.89
|
| Rate for Payer: First Health Commercial |
$9.03
|
| Rate for Payer: Humana Commercial |
$8.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.37
|
| Rate for Payer: Ohio Health Group HMO |
$7.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.56
|
| Rate for Payer: PHCS Commercial |
$9.13
|
| Rate for Payer: United Healthcare All Payer |
$8.37
|
|
|
REUNI MOD HUM STEM LG SZ12
|
Facility
|
OP
|
$21,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,562.50 |
| Max. Negotiated Rate |
$21,000.00 |
| Rate for Payer: Aetna Commercial |
$16,843.75
|
| Rate for Payer: Anthem Medicaid |
$7,522.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,062.50
|
| Rate for Payer: Cash Price |
$10,937.50
|
| Rate for Payer: Cigna Commercial |
$18,156.25
|
| Rate for Payer: First Health Commercial |
$20,781.25
|
| Rate for Payer: Humana Commercial |
$18,593.75
|
| Rate for Payer: Humana KY Medicaid |
$7,522.81
|
| Rate for Payer: Kentucky WC Medicaid |
$7,599.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,937.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,143.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,562.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,673.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,250.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,031.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,093.75
|
| Rate for Payer: PHCS Commercial |
$21,000.00
|
| Rate for Payer: United Healthcare All Payer |
$19,250.00
|
|
|
REUNI MOD HUM STEM LG SZ12
|
Facility
|
IP
|
$21,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,562.50 |
| Max. Negotiated Rate |
$21,000.00 |
| Rate for Payer: Aetna Commercial |
$16,843.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,062.50
|
| Rate for Payer: Cash Price |
$10,937.50
|
| Rate for Payer: Cigna Commercial |
$18,156.25
|
| Rate for Payer: First Health Commercial |
$20,781.25
|
| Rate for Payer: Humana Commercial |
$18,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,937.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,143.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,250.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,031.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,093.75
|
| Rate for Payer: PHCS Commercial |
$21,000.00
|
| Rate for Payer: United Healthcare All Payer |
$19,250.00
|
|
|
REUNI MOD HUM STEM LG SZ9 118M
|
Facility
|
IP
|
$21,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,562.50 |
| Max. Negotiated Rate |
$21,000.00 |
| Rate for Payer: Aetna Commercial |
$16,843.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,062.50
|
| Rate for Payer: Cash Price |
$10,937.50
|
| Rate for Payer: Cigna Commercial |
$18,156.25
|
| Rate for Payer: First Health Commercial |
$20,781.25
|
| Rate for Payer: Humana Commercial |
$18,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,937.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,143.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,250.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,031.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,093.75
|
| Rate for Payer: PHCS Commercial |
$21,000.00
|
| Rate for Payer: United Healthcare All Payer |
$19,250.00
|
|
|
REUNI MOD HUM STEM LG SZ9 118M
|
Facility
|
OP
|
$21,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,562.50 |
| Max. Negotiated Rate |
$21,000.00 |
| Rate for Payer: Aetna Commercial |
$16,843.75
|
| Rate for Payer: Anthem Medicaid |
$7,522.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,062.50
|
| Rate for Payer: Cash Price |
$10,937.50
|
| Rate for Payer: Cigna Commercial |
$18,156.25
|
| Rate for Payer: First Health Commercial |
$20,781.25
|
| Rate for Payer: Humana Commercial |
$18,593.75
|
| Rate for Payer: Humana KY Medicaid |
$7,522.81
|
| Rate for Payer: Kentucky WC Medicaid |
$7,599.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,937.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,143.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,562.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,673.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,250.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,031.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,093.75
|
| Rate for Payer: PHCS Commercial |
$21,000.00
|
| Rate for Payer: United Healthcare All Payer |
$19,250.00
|
|
|
REUNION CEMNT HUM STEM 16*L101
|
Facility
|
IP
|
$21,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,562.50 |
| Max. Negotiated Rate |
$21,000.00 |
| Rate for Payer: Aetna Commercial |
$16,843.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,062.50
|
| Rate for Payer: Cash Price |
$10,937.50
|
| Rate for Payer: Cigna Commercial |
$18,156.25
|
| Rate for Payer: First Health Commercial |
$20,781.25
|
| Rate for Payer: Humana Commercial |
$18,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,937.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,143.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,250.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,031.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,093.75
|
| Rate for Payer: PHCS Commercial |
$21,000.00
|
| Rate for Payer: United Healthcare All Payer |
$19,250.00
|
|
|
REUNION CEMNT HUM STEM 16*L101
|
Facility
|
OP
|
$21,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,562.50 |
| Max. Negotiated Rate |
$21,000.00 |
| Rate for Payer: Aetna Commercial |
$16,843.75
|
| Rate for Payer: Anthem Medicaid |
$7,522.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,062.50
|
| Rate for Payer: Cash Price |
$10,937.50
|
| Rate for Payer: Cigna Commercial |
$18,156.25
|
| Rate for Payer: First Health Commercial |
$20,781.25
|
| Rate for Payer: Humana Commercial |
$18,593.75
|
| Rate for Payer: Humana KY Medicaid |
$7,522.81
|
| Rate for Payer: Kentucky WC Medicaid |
$7,599.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,937.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,143.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,562.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,673.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,250.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,031.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,093.75
|
| Rate for Payer: PHCS Commercial |
$21,000.00
|
| Rate for Payer: United Healthcare All Payer |
$19,250.00
|
|
|
REUNION CEMNT HUM STEM 17*L102
|
Facility
|
IP
|
$21,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,562.50 |
| Max. Negotiated Rate |
$21,000.00 |
| Rate for Payer: Aetna Commercial |
$16,843.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,062.50
|
| Rate for Payer: Cash Price |
$10,937.50
|
| Rate for Payer: Cigna Commercial |
$18,156.25
|
| Rate for Payer: First Health Commercial |
$20,781.25
|
| Rate for Payer: Humana Commercial |
$18,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,937.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,143.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,250.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,031.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,093.75
|
| Rate for Payer: PHCS Commercial |
$21,000.00
|
| Rate for Payer: United Healthcare All Payer |
$19,250.00
|
|
|
REUNION CEMNT HUM STEM 17*L102
|
Facility
|
OP
|
$21,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,562.50 |
| Max. Negotiated Rate |
$21,000.00 |
| Rate for Payer: Aetna Commercial |
$16,843.75
|
| Rate for Payer: Anthem Medicaid |
$7,522.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,062.50
|
| Rate for Payer: Cash Price |
$10,937.50
|
| Rate for Payer: Cigna Commercial |
$18,156.25
|
| Rate for Payer: First Health Commercial |
$20,781.25
|
| Rate for Payer: Humana Commercial |
$18,593.75
|
| Rate for Payer: Humana KY Medicaid |
$7,522.81
|
| Rate for Payer: Kentucky WC Medicaid |
$7,599.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,937.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,143.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,562.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,673.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,250.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,031.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,093.75
|
| Rate for Payer: PHCS Commercial |
$21,000.00
|
| Rate for Payer: United Healthcare All Payer |
$19,250.00
|
|
|
REUNION CEMNT HUM STEM 18*L103
|
Facility
|
OP
|
$21,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,562.50 |
| Max. Negotiated Rate |
$21,000.00 |
| Rate for Payer: Aetna Commercial |
$16,843.75
|
| Rate for Payer: Anthem Medicaid |
$7,522.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,062.50
|
| Rate for Payer: Cash Price |
$10,937.50
|
| Rate for Payer: Cigna Commercial |
$18,156.25
|
| Rate for Payer: First Health Commercial |
$20,781.25
|
| Rate for Payer: Humana Commercial |
$18,593.75
|
| Rate for Payer: Humana KY Medicaid |
$7,522.81
|
| Rate for Payer: Kentucky WC Medicaid |
$7,599.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,937.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,143.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,562.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,673.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,250.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,031.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,093.75
|
| Rate for Payer: PHCS Commercial |
$21,000.00
|
| Rate for Payer: United Healthcare All Payer |
$19,250.00
|
|
|
REUNION CEMNT HUM STEM 18*L103
|
Facility
|
IP
|
$21,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,562.50 |
| Max. Negotiated Rate |
$21,000.00 |
| Rate for Payer: Aetna Commercial |
$16,843.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,062.50
|
| Rate for Payer: Cash Price |
$10,937.50
|
| Rate for Payer: Cigna Commercial |
$18,156.25
|
| Rate for Payer: First Health Commercial |
$20,781.25
|
| Rate for Payer: Humana Commercial |
$18,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,937.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,143.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,250.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,031.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,093.75
|
| Rate for Payer: PHCS Commercial |
$21,000.00
|
| Rate for Payer: United Healthcare All Payer |
$19,250.00
|
|
|
REUNION HUMERAL HEAD SZ40*14MM
|
Facility
|
IP
|
$12,825.47
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,847.64 |
| Max. Negotiated Rate |
$12,312.45 |
| Rate for Payer: Aetna Commercial |
$9,875.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,003.87
|
| Rate for Payer: Cash Price |
$6,412.74
|
| Rate for Payer: Cigna Commercial |
$10,645.14
|
| Rate for Payer: First Health Commercial |
$12,184.20
|
| Rate for Payer: Humana Commercial |
$10,901.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,516.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,465.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,847.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,286.41
|
| Rate for Payer: Ohio Health Group HMO |
$9,619.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,260.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,158.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,849.57
|
| Rate for Payer: PHCS Commercial |
$12,312.45
|
| Rate for Payer: United Healthcare All Payer |
$11,286.41
|
|
|
REUNION HUMERAL HEAD SZ40*14MM
|
Facility
|
OP
|
$12,825.47
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,847.64 |
| Max. Negotiated Rate |
$12,312.45 |
| Rate for Payer: Aetna Commercial |
$9,875.61
|
| Rate for Payer: Anthem Medicaid |
$4,410.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,003.87
|
| Rate for Payer: Cash Price |
$6,412.74
|
| Rate for Payer: Cigna Commercial |
$10,645.14
|
| Rate for Payer: First Health Commercial |
$12,184.20
|
| Rate for Payer: Humana Commercial |
$10,901.65
|
| Rate for Payer: Humana KY Medicaid |
$4,410.68
|
| Rate for Payer: Kentucky WC Medicaid |
$4,455.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,516.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,465.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,847.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,499.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,286.41
|
| Rate for Payer: Ohio Health Group HMO |
$9,619.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,260.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,158.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,849.57
|
| Rate for Payer: PHCS Commercial |
$12,312.45
|
| Rate for Payer: United Healthcare All Payer |
$11,286.41
|
|
|
REUNION HUMERAL HEAD SZ40*17MM
|
Facility
|
IP
|
$12,825.47
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,847.64 |
| Max. Negotiated Rate |
$12,312.45 |
| Rate for Payer: Aetna Commercial |
$9,875.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,003.87
|
| Rate for Payer: Cash Price |
$6,412.74
|
| Rate for Payer: Cigna Commercial |
$10,645.14
|
| Rate for Payer: First Health Commercial |
$12,184.20
|
| Rate for Payer: Humana Commercial |
$10,901.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,516.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,465.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,847.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,286.41
|
| Rate for Payer: Ohio Health Group HMO |
$9,619.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,260.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,158.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,849.57
|
| Rate for Payer: PHCS Commercial |
$12,312.45
|
| Rate for Payer: United Healthcare All Payer |
$11,286.41
|
|
